CPC-150 Tuberculosis and Systemic Diseases

Abstract

Background The immunosuppression of systemic diseases makes the management of patients with tuberculosis more complicated.

Purpose To monitor the clinical evolution of tuberculosis in patients suffering from systemic diseases.

Materials and Methods A retrospective study, from 1998 to 2012, in the internal medicine service in Rabta hospital, Tunisia, of 9 patients (8
women and a man, median age: 54 years) suffering from connective tissues disease, treated by corticosteroids linked in one
or several treatments to immunosuppressants, who subsequently developed tuberculosis.

Results The median time to diagnosis was 116 days (7d – 1 year). The location of the tuberculosis was pulmonary (n = 2), ganglionic
(n = 3), urogenital (n = 2), tubercular spondylodiscitis (n = 1), more than one location (n = 1). The diagnosis of tuberculosis
was confirmed by bacteriology (n = 4) four cases, histologically (n = 5) and by a test treatment (n = 1). Systemic illnesses
were: systemic lupus erythematous (n = 5), Gougerot-Sjögren syndrome (secondary or primary) (n = 3), sarcoidosis (n = 1),
systemic scleroderma linked to pernicious anaemia (n = 1), rheumatoid arthritis (patient 2 linked to lupus) (n = 1) and multiple
auto-immune syndrome (n = 1). The diagnosis of systematic illness was made before that of tuberculosis in 8 patients and concomitantly
in only one. Under treatment by four drugs then by two drugs, the evolution of tuberculosis was favourable in five of nine
patients. One of the patients developed an allergy in isoniazid and resistance to the anti-tubercular treatment. Five of our
patients recovered from their illness.

Conclusions This study confirms the often extra-pulmonary character of tuberculosis in patients with systemic disease as well as the difficulty
of diagnosis and problems multiplied by this association.